recommends that stroke survivors should undertake: strength training to increase independence in activities of daily living, flexibility training to increase range of movement and prevent deformities, and training to enhance balance and coordination. The AHA advises that each of these exercise modalities should be carried out twice or three times per week with the view to improving functional outcome after stroke. Aerobic exercise of moderate intensity should be carried out on at least three days of the week for twenty to sixty minutes at a time, in order to increase physical activity capacity, improve walking and independence, and reduce the risk of cardiovascular disease [3]. This guidance is derived, at least in part from the extrapolation of data from other non-stroke populations.
ISRN Neurology 7
Limitations highlighted in previous studies which have investigated the benefits of exercise in the prevention of stroke inhibit definitive conclusions regarding the type, frequency, and intensity of exercise that is required to confer a protective effect. Although some trials have included data on haemorrhagic stroke, the main body of evidence is for ischaemic stroke, and data on physical activity and haemorrhagic stroke are lacking in comparison. Profitable topics for further investigation should focus on defining the optimal intensities and durations of exercise required to provide the most substantial reduction in stroke risk for use in both primary and secondary prevention, the frequency of exercise sessions, the effect of gender on risk reduction with exercise, and the duration of observed benefit. For patients with previous stroke, identification and targeting of barriers to exercise delivery could lead to more widespread implementation of exercise prescription in this population. The long-term effect of regular physical activity on recurrent stroke risk in patients with previous stroke merits further study.